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An Overview of the Course. History of medicine timeline The prehistoric period – 3000 BC to 43 The first 3,000 years of our study fall in the prehistoric period. 'Prehistory' means before writing, which means we have to rely on other sources for information about health and medicine. Archaeologists can use cave paintings and preserved skeletons to find out what life was like. We can also study people whose lives have not changed for thousands of years, like Aborigines. We think that people at this time believed illness was caused by spirits. Charms were used to ward off sickness. Surgery There was very limited use of surgery in prehistoric times. One amazing operation did take place. This was trepanning or trephining, which involved cutting a hole in the skull, possibly to release evil spirits which were causing illness. Archaeological evidence suggests that people did survive trepanning, although we don't know whether it had any positive effects. The Ancient World The ancient world During the prehistoric period there was progress in other parts of the world – particularly the Egyptian, Greek and Roman civilizations. Although these ancient civilizations produced the world’s first doctors and reasoned medical theories, most ideas about the causes and treatment of diseases were based on superstition. In Britain, for most of this period, their was no medical progress. It was only when the Romans came that there was any investment in medicine. Egyptian medicine Egyptian’s medical knowledge and beliefs The Greek Empire Greek society The success and wealth of the Greek Empire allowed the Greeks to develop a love of learning and to try to find answers to the mysteries around them. There were two main strands to Greek medicine. The first stemmed from their strong belief in the gods. The god of healing was Asclepius (also spelt Asklepios or Aesculapius). The second stemmed from new ideas from Greek doctors, the most famous of whom was Hippocrates. The most famous of these Asclepeia was built at a remote location called Epidaurus, and was part of what would be regarded today as a health complex! Remains of the stadium at Epidaurus. Remains of the gymnasium at Epidaurus. There were baths, a gymnasium, a stadium, a library, a theatre and accommodation, as well as temples to other gods. New Greek medical ideas As well as believing in the healing powers of Asclepius, there was also a lot of respect for other medical theories. The Greeks loved philosophy and came up with lots of new ideas as a result. One important Greek philosopher was Aristotle, who originally developed the Theory of the Four Humours which became the basis for Greek medical practice. Hippocrates developed the theory further. Despite being wrong, it was a theory which was to be widely used by doctors for nearly 2,000 years. The reliance on the theory was so heavy that it prevented doctors from looking elsewhere for causes of disease. The Theory of the Four Humours The Theory of the Four Humours was influenced by Greek ideas about balance. The Greeks believed that the world was made up of four elements: Air Fire Earth Water They noted that these elements had different properties – water was wet, fire was hot, etc. Through observing the four seasons, they believed that each season must have a dominant element. Greek doctors noted that patients’ symptoms varied with the seasons – heat rashes in summer, wet runny noses in winter. From this, they deduced that the human body was made up of four vital liquids which they referred to as ‘humours’: blood phlegm yellow bile black bile. Each of the humours was related to a season and element: Air Fire Earth Water Spring Summer Autumn Winter Blood Yellow bile Black bile Phlegm The theory stated that these humours had to be in balance for the body to be well, that is there had to be the correct amount of each fluid. In order to find out which humour was imbalanced, Greek doctors would perform a diagnosis on the patient by studying their symptoms. Diagnosis Prognosis Observation Treatment Clinical diagnosis If there was too much or too little of one or more of the humours it was thought that the person would become ill. Medical treatments aimed to put the humours back in balance. Can you explain why Hippocrates is regarded as such an important figure in the development of medicine? Growth of the Roman Empire •Roman Army •Hygiene •Public Health •Preventative Methods of Illness How did the Romans improve public health? Religious beliefs Although there were developments in medicine and public health, many people still relied on the gods for cures. This was often their first step in treating disease. People prayed to Salus, the Roman goddess of health, and the Greek god of medicine, Asclepius. Galen Rome’s most famous doctor was Galen. Name: Galen Born: AD 129 in Greece Occupation: Doctor Education: Studied medicine from age 17; Later studied in Alexandria. Career highlights: Worked in an Asclepeia in Greece; Surgeon at gladiators’ school; Doctor to the Roman emperor Marcus Aurelius; Teacher of doctors. Galen’s four methods and his importance The fall of the Roman Empire The Roman Empire grew until it could no longer control its borders successfully. Barbarian tribes overran the western parts of the empire, and by AD 500 Europe consisted of many small, feuding tribal kingdoms. These kingdoms were often at war with each other. What effects do you think these wars had on the benefits that the Roman Empire had brought? The Middle Ages – AD 500 to 1400 The Middle Ages saw some medical progress, including the setting up of universities, and some regress (decline), due partly to the end of the Roman Empire, when much of the knowledge of the ancient civilizations was lost. In the Middle Ages the church controlled those who were allowed to practise medicine and new ideas were not encouraged. Life expectancy was just 36 years for women and 37 for men, compared to 38 and 40 years for those living in the Greek and Roman civilizations. 37 36* What other barriers do you think might have existed against the development of medicine at this time? * Life expectancy figures are almost impossible to verify and are rough estimates only. The church and medicine The Black Death In 1348–49 Britain faced the worst crisis in its history. A deadly disease, originating in Asia, arrived from Europe. This disease was the bubonic plague. The symptoms were a fever, headache, tiredness and painful swellings (buboes) the size of apples in the groin and armpits. Small, oozing red and black spots appeared all over the body, giving the disease the name the Black Death. Many patients only lasted a few days before a painful death. Nearly 40% of the English population died. What was believed to cause the Black Death? It was not until 1894 that it was discovered that the bubonic plague was caused by germs, carried by the fleas which live on black rats. Back in 1349 people had very different ideas about the cause of the disease. Look at the list of the causes people believed in on the next slide. Which beliefs have we seen already in prehistoric medicine? Which beliefs are new? Why do you think no one suspected the fleas? Breathing bad air (miasma) – medieval towns were very smelly and the smell was supposed to contain diseases. Touching a victim. The position of the planets – the relationship of the planets and the movement of the Sun affected health. Annoying God – the plague was his punishment. What did people believe caused the Black Death? An imbalance of the body’s four humours – Galen can’t be wrong! Looking at a victim – the disease was spread by eye contact. Drinking from poisoned wells – Germans believed the Jews were poisoning drinking water to kill off non-Jews. The Medical Renaissance – 1400 to 1750 Renaissance means ‘rebirth’. The Renaissance period in Europe saw a rebirth of the learning and knowledge lost from the Classical period (Greek and Roman civilizations). This was a time when many new discoveries were made about the human body, some of which over-turned ideas that had been around for more than a thousand years. Despite these new developments, health hardly improved as many doctors were suspicious of new ideas, and there was still no knowledge of what caused disease. Life expectancy for women increased by about two years, and for men four years. * Life expectancy figures are almost impossible to verify and are rough estimates only. 41 38* Renaissance Man #1 – Andreas Vesalius Andreas Vesalius studied the human body very closely. His books contained very precise drawings of the human body and had a big impact on anatomy. Vesalius dissected human bodies to help him understand how they worked and commission life-like drawings. Galen had dissected animals, but this had led to mistakes. Because Vesalius had a detailed knowledge of the way the human body was put together, he was able to challenge some of Galen’s ideas, which had been accepted for over a thousand years. For example, Vesalius found that Galen had been wrong about the human jaw. Galen wrote that it was made of two bones, whereas Vesalius found only one. He also found that the septum in the heart was too thick and had no holes for the blood to flow through, as Galen had said. The impact of Vesalius’s work Vesalius showed that some of Galen’s ideas were wrong. Many doctors refused to believe him, but his work did encourage doctors to question ancient ideas rather than just accept them. In the long-term, Vesalius’s work on anatomy was of huge importance and helped doctors make new discoveries about the way the body worked. What impact do you think Vesalius had on ordinary people’s lives? How much of a difference did he make to the development of medicine? Renaissance Man #2 – Ambroise Paré Ambroise Paré was a French army surgeon who treated many wounded soldiers on the battlefields. He became an expert in treating sword and gunshot wounds. He is important for two major discoveries. At the time, surgeons used cauterization to treat gunshot wounds. This meant sealing the wound with a redhot iron, then pouring boiling oil on it to stop infection. On the battlefield, Paré ran out of oil. In desperation, he created a cold ointment of egg white, rose oil and turpentine. The next day he found that soldiers treated with this salve felt less pain than those treated with hot oil. Paré’s second major discovery was that of ligatures. This was a method of sealing a wound after a limb was amputated. Paré thought that instead of cauterizing the wound, surgeons should try to tie the arteries and veins with thin silk threads. However, ligatures for amputations were not really practical until the invention of the tourniquet two centuries later. Also, without antiseptics or knowledge of germs, the silk thread used as ligatures easily carried bacteria into the body and caused infection. Renaissance Man #3 – William Harvey William Harvey was an English doctor who discovered how the heart worked and how blood circulated around the body. Before Harvey, doctors had learnt from Galen that the body used blood like a fuel. He had written that the liver continually produced blood to replace that which the body had burnt up. Harvey’s discoveries included that: the heart works like a pump blood flows in one direction only around the body one-way valves stop the blood going the wrong way blood is re-circulated and not replaced. What did Harvey prove? Harvey showed that blood returns to the heart from the body via veins. It is then pumped to the lungs. Blood carrying oxygen flows from the lungs to the heart. Blood leaves the heart to circulate round the body via arteries. Harvey’s methods Harvey’s methods included: Dissecting live, cold-blooded animals. Their very slow heartbeat allowed him to observe the actions of the heart. He also gained a good knowledge of the human body through dissection. Carrying out hundreds of painstaking experiments. Carefully recording all his findings so that he could prove why he was right. Calculating the total volume of blood by measuring the amount of blood pumped by each heartbeat. Experimenting with rods in the veins. He found he could only push them through the valves one way. The impact of Harvey’s work Harvey couldn’t see the tiny capillaries which carry blood, though he knew they must exist. With the invention of the microscope in the 17th century, Harvey was proved right. Like Vesalius three-quarters of a century before him, Harvey had dared to challenge Galen and the other ancient writers. Many doctors again regarded these new ideas as dangerous and carried on with their own methods. However, Harvey’s discoveries were vital to the understanding of the way the body works we have today. What impact do you think Harvey had on ordinary people’s lives? How much of a difference did he make to the development of medicine? The medical Renaissance – a summary Despite the medical advances made by Vesalius, Paré and Harvey, the Theory of the Four Humours was still used to treat sick people and there was little change in the medical methods used. Ordinary people still used wise women and herbal remedies. The Industrial Revolution – 1750 to 1900 It was during the Industrial Revolution period that the causes of disease were discovered, and scientists and doctors could then use their knowledge of ‘germs’ to begin to find cures. Preventing illness was also important and the invention of vaccinations began to eliminate certain killer diseases such as smallpox. Public Health Acts were passed which helped improve conditions in towns. The discovery of antiseptics and anaesthetics improved surgical techniques. These improvements led to a greater life expectancy, but poor living and working conditions prevented any further progress. * Life expectancy figures are almost impossible to verify and are rough estimates only. 45 49* Killer diseases of industrial towns Correct answers are in the notes below (click on View, Notes Page). Housing was overcrowded (often 10 people in one room) and often damp. There was little sanitation. Why did these diseases became enormous Why people in Britain suffer problems indon’t the new industrial towns? from these diseases today? Lack of fresh water – water was often contaminated with sewage. Poor diet, pollution and long working hours in factories weakened people’s resistance to diseases. Inoculation In our society, babies are vaccinated to stop them catching diseases. But until the 19th century, vaccination was not known. Until then, the only method available to prevent smallpox, one of the deadly diseases, was inoculation. Inoculation had been introduced to Britain by Lady Wortley Montague, who had seen ‘smallpox parties’ in Turkey. Inoculation gave a mild dose of smallpox, with the aim being long-term immunity to the disease. “…the old woman comes with a nutshell … of smallpox, and rips open [a vein] and puts into the vein as much smallpox matter as can lie upon the head of her needle.” This method was often effective but it could have a terrible side-effect: what do you think this was? Edward Jenner and vaccination Edward Jenner (1749–1823) trained as a doctor in London. He set up practice in Gloucestershire and, like other doctors, offered smallpox inoculation to his patients. Jenner was surprised to find that many people refused the inoculation. According to local folklore, those who had had cowpox (a cattle disease passed on to dairymaids and other farm workers) never caught smallpox. Jenner wondered whether inoculating patients with cowpox would give them immunity against smallpox. It would be less dangerous than inoculating them with smallpox matter, because cowpox was only a mild illness. Jenner’s first vaccination The impact of Jenner’s findings Jenner sent his findings to the Royal Society but many were opposed to his idea and the society refused to publish his work. Using his own money he published the work himself in 1798 and it was read by many people all over the world. At last his work was recognized and the government gave him large amounts of money to open and run a vaccination clinic in London. Around the world, the smallpox vaccination was used to protect people against the deadly disease. In 1852, smallpox vaccination became compulsory in Britain. It is now wiped out as a disease. Understanding the cause of disease A major feature of the history of medicine before the 19th century was the lack of understanding of the causes of disease. Without that knowledge, attempts at the prevention and treatment of disease were based on superstition and guesswork. In the 1850s, however, one man was to make a major breakthrough in the discovery of what caused disease – Louis Pasteur, a French scientist. Louis Pasteur and germ theory Pasteur trained as a chemist in Paris and then developed an interest in biology. He worked at Lille University, in the heart of an industrial area. There he specialized in fermentation. He investigated why vats of beer kept going bad at a local brewery. Pasteur discovered it was because of micro-organisms in the beer. He called these germs because they were germinating, or growing. His theory was that these germs were causing the decay. Spontaneous generation and germ theory How did he do it? Pasteur was not the first to discover micro-organisms, but he was helped hugely by the powerful microscope lenses developed in the 19th century, which could magnify 1,000 times without distortion. Pasteur’s ideas were ridiculed by some scientists and he knew he had to have undisputed proof. He carried out a number of carefully planned and recorded experiments. Next you will learn how Pasteur carried out his experiments. Think how individual genius and technology helped the discovery of the germ theory. Pasteur’s experiments To prove that micro-organisms lived in the air, Pasteur collected air in sterile flasks in Paris. He found that bacteria grew in the flasks. By repeating this experiment in different places he found that the air in some places, like Paris, had far more micro-organisms in it than places without so many people or so much pollution. Air from Paris Air from a less polluted area Pasteur applied his theory of decay by micro-organisms in beer to the cause of disease in humans. If bacteria could cause beer to go bad, then presumably they could make animals and humans ill. He looked at the French silk industry, which was suffering because of a disease attacking silkworms. Pasteur identified the bacteria which was causing the disease. He also proved that bacteria could be killed by heating a liquid in a flask which he then sealed. It remained fresh. Today we have pasteurized milk – heated to kill harmful bacteria. Robert Koch Robert Koch was a German doctor who built on Pasteur’s germ theory. During the late 1870s he identified the bacteria which caused anthrax, a disease in cattle, sheep and sometimes humans. He achieved this by meticulous experiments and research. He injected the bacteria that he thought caused anthrax into 20 generations of mice. All the mice caught the disease and the bacteria he isolated in the last generation were the same as those that he had started with. Koch used the painstaking method of experiment in his work. Using the same process, his team of scientists identified the bacteria causing cholera and tuberculosis. He also developed a medium for growing the bacteria and a method of staining them so that they could be identified and classified. What were Koch’s main contributions to medical development? There was great competition between Koch and Pasteur, not just scientifically, but also because of Germany’s defeat of France in the Franco-Prussian war of 1871. vs. How might the rivalry between Pasteur and Koch have been both good and bad for the progress of medicine? Pasteur’s search for vaccinations Pasteur continued his search for vaccines by trial and error. He was asked to look at chicken cholera, because it was devastating French farming. He isolated the chicken cholera bacteria and injected chickens with different strengths of it, without success. His laboratory closed for the holidays in the summer of 1879. Pasteur was now to have a bit of luck. Some chicken cholera bacteria were left out, exposed to the air. The bacteria were weakened severely and when injected into chickens had no effect. When subsequently injected with new bacteria (which should have killed them) the chickens suffered no ill effects. Pasteur had found a vaccine against chicken cholera. Apart from helping the French farming industry, why was Pasteur’s discovery so important? By 1881, Pasteur and his team had developed a vaccine for anthrax. To prove it worked, he vaccinated 25 sheep with a weak strain of the disease. Injected with weak anthrax strain No injection Two weeks later he injected both the vaccinated and unvaccinated sheep with the full strength bacteria. Injected with full strength anthrax Injected with full strength anthrax The 25 vaccinated sheep remained fit and well, whereas the unprotected 25 sheep all died. Sheep all well Sheep all dead Koch criticized Pasteur’s methods, but in spite of this Pasteur achieved international acclaim for his discoveries. Two years later he had developed a vaccine for rabies, a terrible disease in dogs. A bite from a rabid dogs was fatal to humans. Doctors now knew that once the bacteria causing a disease had been identified, a vaccine could be searched for. By the end of the 19th century the causes of the following diseases had been identified: smallpox, TB, cholera, typhus, tetanus, pneumonia, meningitis, plague, diphtheria and dysentery. All of these were killer diseases against which there had previously been no protection. The development of anaesthetics Surgery without anaesthesia had to be fast. Napoleon’s surgeon amputated 200 limbs in 24 hours at the Battle of Borodino in 1812. During the 18th and 19th centuries, scientists experimented with the properties of chemicals and the effect they had on humans. In 1799 Humphrey Davy (who later invented the safety lamp for miners) discovered that pain could be reduced by using laughing gas. Ether was later found to put patients to sleep, and was used successfully as an anaesthetic. However, it could cause the patient to cough or vomit, not ideal when a surgeon is cutting them with a knife! It was also highly inflammable. James Simpson In 1847, a breakthrough was made by James Simpson, a professor at Edinburgh University. He and several assistants tested several different chemicals at his home. In the process a bottle of chloroform was knocked over and when Mrs Simpson entered the room she found them all asleep. Simpson was so excited with the effects of chloroform that he used it on 30 patients that week. Now operations could be performed at a sensible speed, and more intricate operations could be attempted. Yet many were fiercely opposed to pain relief. Some feared side effects from the new anaesthetic, and an overdose could kill. Others objected to pain relief during childbirth, claiming that pain was sent by God. In 1853, however, Queen Victoria was given chloroform during the birth of her eighth child. Her approval of it was enough to silence the critics and put it into general use. The development of antiseptics For generations, surgeons had gone from one operation to the next without washing their hands or wearing masks or gowns or overalls. Infection was the cause of many post surgical deaths, with gangrene being very common. A far higher proportion of women who gave birth in hospitals died of infection than those who gave birth at home. Joseph Lister Joseph Lister was a surgeon who had studied Pasteur’s work with interest. He thought that the high death rate of surgical patients might be caused by the micro-organisms in the air. Lister experimented by spraying wounds with carbolic spray to kill the microbes. He found his patients healed without developing gangrene. There was opposition to his ideas by other surgeons. Complaints included: antiseptics cost money Lister’s methods extended surgery time many did not accept the germ theory. In 1878 Koch identified the bacteria which caused septicaemia (blood poisoning). Within a few years Lister’s antiseptic procedures were finally in place in most operating theatres. These procedures included: meticulous cleaning of hospitals and theatres steam-sterilization of all instruments use of sterilized rubber gloves. Lister also applied his antiseptic idea to ligatures, used to tie blood vessels. He used catgut which could be sterilized and would be less likely to cause infection. Blood transfusions Although Lister had improved the use of ligatures, it was still not possible at the end of the 19th century to replace lost blood through blood transfusions. Not only did doctors not know how to stop blood clotting, but when they did manage transfusion the patient often died, which they could not explain. In the 20th century it was discovered that there were different blood groups. Florence Nightingale While they couldn’t become doctors, women were still regarded as natural nurses. They tended to come from the middle classes, it being seen as too lowly a job for wealthier women. One such woman was Florence Nightingale (1820–1910). Her upper-class upbringing had groomed her for marriage to a rich man, not a career. Florence, however, believed that God was expecting her to be a nurse. Nightingale visited many hospitals to learn about nursing and was appalled by the conditions of the buildings, the nurses and their level of care. In 1854, the government asked her to go to the Crimea to help at the army hospitals set up to treat the wounded in the war between Russia and Britain. The conditions were awful; half the soldiers had died in the hospitals. The Crimea Nightingale transformed the Crimean hospitals in six months. She insisted on good food for her patients, clean airy wards, boiled sheets and taught her team of nurses professional nursing practise. When the army refused to pay for what she said she needed, she bought it herself. Her improvements reduced the death rate amongst her injured soldiers from 50% to 3%. She gained the nickname ‘Lady with the Lamp’. On her return to England, Nightingale worked to improve conditions in British hospitals. She set up a training school for nurses. Her influence on the nursing profession continues today. The 20th century In the 20th century more progress was made in improving medicine and health than in the previous 5,000 years. The causes of most diseases were discovered in the 20th century, and by the year 2000 the vast majority of illnesses could be prevented or cured. Shorter working hours, better housing, the introduction of a free National Health Service and better diets all led to far higher life expectancy than ever before. 72 78* There are many reasons for improvements in health in the 20th century. Which do you think has had the biggest effect? * Life expectancy figures are almost impossible to verify and are rough estimates only. World War I Between 1914 and 1918 a totally new type of war ripped Europe apart. Huge quantities of mass-produced weapons caused unprecedented death rates and horrendous injuries. Instead of men fighting one to one, a machine gun could obliterate hundreds in a few moments. This cemetery in Belgium contains the graves of 11,000 soldiers who died at the Battle of Passchendale in 1917, and commemorates the 33,000 whose bodies were never found. How World War I affected medicine The huge number of casualties meant that surgeons and doctors gained a wealth of surgical experience. Practice led to improvements in mending broken bones, grafting skin and all types of surgery. These surgeons were used to working in clean, wellequipped hospitals. Suddenly they were trying to operate in dirty conditions just behind the front line or in a field hospital, often without the supplies they needed. This led to them having to improvise, resulting in new discoveries. Paré had improvised on the battlefield almost 400 years earlier. The experience gained in the war led to many surgeons specializing in different forms of surgery after the war. Were these benefits realized in the short- or long-term? Can you think of any ways in which World War I hindered the progress of medicine? The fight against infection World War I interrupted an important research programme into fighting infection. Research had been going on for years to find a chemical compound which would kill bacteria in the body. Robert Koch had found a way of staining bacteria to identify them. Paul Ehrlich, a member of his team, decided to take this idea further. Ehrlich thought that a chemical compound could be used not only to stain the bacteria causing an infection, but which would kill them (and only them) as well. Ehrlich said this would be like a magic bullet. What do you think this means? Magic bullets A magic bullet would ‘shoot’ the bacteria, but not harm the patient. Ehrlich had seen how the body produces antibodies to attack the specific bacteria causing an infection, and believed he could find a chemical which would work in the same way. After many years, in 1909 he was proved right. His team had tried 605 varieties of an arsenic compound to cure syphilis, a common venereal disease. The 606th one killed the syphilis bacteria. They had discovered the first magic bullet, and they called it Salvarsan 606. This was a major step in the progress of medicine, although Salvarsan 606 needed to be improved upon, because it could kill the patient as well as the infection as it was made from arsenic. After World War I research into magic bullets resumed. The number of men who had died because of infection in the trenches made it all the more necessary. Salvarsan 606 injecting kit c. 1920. In 1932 Gerhard Domagk found the second magic bullet after years of methodical research. This was a red dye called Prontosil. He injected mice with a lethal dose of a streptococcal infection. He then injected them with Prontosil, which cured them. Soon he had the chance to try it out on a human, his own daughter, who was seriously ill with the same streptococcal infection. Having no other cure, he injected her with Prontosil and she recovered. The next task was to find out which component of Prontosil made it a magic bullet. With the aid of the new, powerful electron microscopes which had been in use since the early 1930s, scientists found that the active ingredient was a sulphonamide which came from coal tar. The discovery of sulphonamides led to the development of drugs which cured gonorrhoea, pneumonia, meningitis and scarlet fever. They led to the number of mothers dying following postnatal infection being slashed from 20% to 4.7%. Fleming and the discovery of penicillin Alexander Fleming had worked on wounds and infections during World War I and spent years researching the body’s natural defences against infection. In 1928, chance helped the scientific search for anti-bacterial drugs, as it had helped Pasteur. Fleming returned from holiday to find that mould had grown on the cultures in some of the petri dishes in his laboratory. He noticed that in one dish the staphylococci cells had disappeared around the edges of the mould. He realised that the mould had killed the bacteria. He identified the mould as penicillium, which had probably blown in through the open window. The development of penicillin Fleming had discovered that penicillin would attack certain forms of bacteria, but he did not have the resources to research whether or not it could be used to fight infection. Two British scientists, Howard Florey and Ernst Chain and their assistants, continued with the study. Florey and Chain grew penicillium (the mould which produces penicillin) to experiment with, and tested successfully on mice. In 1941 they conducted a trial on a dying man, who recovered until they ran out of penicillin. To continue their research, they looked to the USA, who had entered the war in 1941 and feared heavy casualties. It financed drugs companies to mass-produce penicillin. By 1945 the US army used 2 million doses a month. The first antibiotic had been created. The effects of World War II on medicine The entry of the USA to World War II had an impact on the development of penicillin. The war had other effects as well. The National Health Service (NHS) In 1942, William Beveridge, a civil servant, advised the government to set up a welfare state, including a free national health service, which was to give benefits ‘from the cradle to the grave’ for all. The plans were passed by the post-war Labour government in 1946. Two years later the National Health Service (NHS) began. It was available free to everyone in the nation, and was to cover every aspect of health care. Training of doctors and nurses Medical aids Hospitals and ambulance service Dentistry Vaccination programmes Medical research What the NHS provides Eye tests Consultants Medicines Surgery Maternity care GPs, surgeries, health clinics, district nurses. The effect of the National Health Service on people’s health was dramatic. For the first time ever, everyone had the right to free health care. Before the NHS many could not afford to visit the doctor, let alone buy medicines or have regular treatment. By the end of the 20th century, however, the NHS was facing one financial crisis after another. Prescription charges, introduced in the 1950s, rose steeply. Charges were introduced for dental treatment and eye tests. Unable to pay for the necessary staff, many beds remained empty while the waiting lists grew longer. Despite the problems, anyone could be treated free when needed, regardless of their ability to pay or whether they had insurance. What diseases kill people today? Medicine and health progressed dramatically during the 20th century. Vaccination meant that diseases such as smallpox or diphtheria were no longer a threat. Other illnesses became treatable with antibiotics. Previously incurable conditions can be treated with the latest surgical techniques. There are, however, diseases which kill people today which were not known in earlier times. What modern diseases can you think of? Factors affecting medicine in the 20th century Match up the individuals with their discoveries Andreas Vesalius The circulation of the body. Ambroise Pare Discovered Chloroform as a form of anaesthetic. William Harvey Small pox vaccination formed from cowpox Jenner Using carbolic spray over the wound during surgery limited Infection Louis Pasteur Came up with the Germ theory Robert Koch Isolated and stained Bacteria James Simpson Tied ligatures to stop bleeding. Stopped using hot oil and instead used his own mixture. Joseph Lister showed that Galen was wrong in some important ideas. – Jaw / Heart Match up the individuals with their discoveries Andreas Vesalius Vesalius showed that Galen was wrong in some important ideas. – Jaw / Heart Tied ligatures to stop bleeding. Ambroise Pare Stopped using hot oil and instead used his own mixture. William Harvey The circulation of the body. Jenner Small pox vaccination formed from cowpox Louis Pasteur Came up with the Germ theory Robert Koch Isolated and stained Bacteria James Simpson Discovered Chloroform as a form of anaesthetic. Joseph Lister Using carbolic spray over the wound during surgery limited Infection Four-in-a-row